Stage of Change Algorithm

T H E C O U N S E L I N G I N T E R V I E W

H N D S 4 5 0 / 5 9 0 N U T R I T I O N C O U N S E L I N G & C O M M U N I C AT I O N

P R O F E S S O R D O O L E Y F A L L 2 0 1 6

MOTIVATIONAL NUTRITION COUNSELING ALGORITHM

• Directs the flow of a nutrition counseling session – 4 phases: involving, exploration/education, resolving, & closing

• Incorporates – TTM

– MI

– Solution-focused therapy

– Self-efficacy

• Motivation is the underlying force for behavior change – 3 levels of motivation

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S TA G E 1 : I N V O LV I N G

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INVOLVING PHASE COMPONENTS

1. Greeting, Comfort, Small Talk

2. Opening

3. Identify Client’s General Goals

4. Explain the Counseling Process (first session)

5. Discuss Monitoring

6. Setting the Agenda for the Session

7. Transition to the Next Phase

10-15 minutes

INVOLVING PHASE • First stage of the session used to build the relationship 1. Greeting, comfort, small talk

2. Opening with an open-ended question – Focus is on specific counseling responses

• Relationship-building: empathizing, legitimation, respect

• Reflective listening

• Paraphrasing, summarizing, clarifying, open-ended questions

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INVOLVING PHASE, CONTINUED 3. I.D. Client’s LT Behavior Change Objectives

– While discussing needs and expectations of the client

– Goal can be general in nature (i.e. to improve quality of diet)

4. Explain Counseling Process – Describe what will basically happen throughout the

counseling program

– Review Informed Consent Form (obtain signature)

– See p.84 for example explanation

INVOLVING PHASE, CONTINUED 5. Discuss Weight Monitoring

– Let client make decisions about weighing

– Weighing in works for some but not for others • Who performs the weigh-in? Where? When? How often?

6. Setting the Agenda – First Session: Explain the flow of the session

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INVOLVING PHASE, CONTINUED 6. Setting the Agenda

– Other Sessions: come to an agreement with the client after • Asking the client about any issues they want to address

• Explaining your intentions for the session (education, exploration, etc.)

• Sharing any additional assessment data that might bring up other issues

7. Transitioning into the Next Phase – Proper facilitation includes

voicing direction of the session • Make a statement indicating that you

both are moving on

S TA G E 2 : E X P LO R I N G & E D U C AT I N G

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EXPLORATION-EDUCATION PHASE 1. Education

2. Assessment

3. Providing Nonjudgmental Feedback

4. Client’s Thoughts on Assessment vs. Standards

5. Summarize

6. Assess Readiness to Make a Change

EXPLORATION-EDUCATION PHASE 1. Education

– Main focus: address health risks associated with your client’s eating pattern

2. Assessment – Some of the basic assessment techniques are discussed in Ch. 5

– Have client fill out assessment forms prior to session

• Have client discuss how they felt when filling them out and what they think about them

– Do not be redundant

• Client Assessment Questionnaire (LMF 5.1 on pp. 402-404)

• Food Frequency Questionnaire (LMF 5.4 on p. 408)

• Medical Release Form if necessary for weight loss (LMF 8.5 on p. 432)

– See example phrasing on p. 86

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• Use assessment and discussion to determine which topics to explore

• Assessment can also include the description of a typical day

– Refer to Exhibit 4.2 on p. 87

– A typical day of your life and mention where food fits in

EXPLORATION-EDUCATION PHASE

PRACTICE – TYPICAL DAY STRATEGY

• Partner up with someone • One person is the client and one is the counselor

– Counselor – request the typical day information

• Make note of important concepts (not every detail)

• Simple, open questions – “And then what?” “How did you feel then?”

• Avoid providing hypotheses, ideas, or intricate questions

• Listen and get an idea of what this person goes through everyday

– Client – comply and provide typical day routine

• Discuss daily routines, encounters, and mention foods as part of it

– Typically takes 10-20 minutes

• Switch roles if time permits

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TYPICAL DAY STRATEGY • Explain the overall information that you obtained as

the counselor. – Outside of diet, how did you learn about this person’s life?